COVID-19 vaccination-related headache showed two different clusters in the long-term course: a prospective multicenter follow-up study (COVA-Head Study).

BACKGROUND: Although acute headache following COVID-19 vaccination is widely acknowledged, the long-term progression of these headaches remains poorly understood. Our objective was to identify various phenotypes of prolonged or worsened headaches associated with COVID-19 vaccination and document any changes in these phenotypes over an extended period. Additionally, we aimed to document the diverse headache presentations among patients with pre-existing primary headaches. METHODS: A multinational, prospective observational study was conducted to investigate prolonged or worsened headaches associated with COVID-19 vaccination. Questionnaires assessing COVID-19 vaccination-related headaches at three time points (initial visit, 3rd month follow-up, and 6th month follow-up) were developed for the study. Headache specialists/clinicians evaluated patients using these questionnaires in a prospective manner. Repeated K-means cluster analysis was performed to identify patient profiles with prolonged or worsened headaches related to COVID-19 vaccination. RESULTS: Among the 174 patients included in the study, there was a female-to-male ratio of 128 (73.6%) to 46 (26.4%). The mean age of the patient group was 45.2 ± 13.3 years, and 107 patients (61.5%) had a pre-existing history of primary headaches. Through the analysis, two major clusters were identified based on headache characteristics at each visit. During the first visit (n = 174), Cluster 1 primarily comprised patients with a history of primary headaches, frontal localization of pain, throbbing pain type, more severe headaches accompanied by symptoms such as nausea, phonophobia, photophobia, and osmophobia, and worsened by physical activity. In contrast, Cluster 2 consisted of patients with longer headache durations (over one month) and a stabbing/pressing quality of pain. Patients in Cluster 1 had a higher prevalence of migraine as the pre-existing primary headache disorder compared to Cluster 2 (90.48% vs. 68.18%, respectively; p = 0.005). CONCLUSION: The identification of two distinct phenotypes of prolonged or worsened headaches related to COVID-19 vaccination can provide valuable clinical insights. Having an awareness of the potential worsening of headaches following COVID-19 vaccination, particularly in patients with a primary headache disorder such as migraine, can help clinicians and headache experts anticipate and adjust their treatment strategies accordingly. This knowledge can aid in preplanning treatment modifications and optimize patient care.

One Patient, Three Providers: A Multidisciplinary Approach to Managing Common Neuropsychiatric Cases.

BACKGROUND: Neuropsychiatric cases require a multidisciplinary approach for effective management. This paper presented case-based discussions on migraine, dementia, epilepsy, mood disorders, neuralgia, and psychosis from the perspectives of a family physician, neurologist, and psychiatrist. The goal was to highlight the importance of collaboration between healthcare providers in managing these complex cases. METHODS: The paper was based on the proceedings of the Mediterranean Neuropsychiatry Symposium, where experts from family medicine, neurology, and psychiatry came together for comprehensive case-based discussions. The CARE framework (Case Report, Appraisal, Research, and Education) was developed to guide reporting and evaluation of case reports in clinical practice. RESULTS: Six cases were presented and discussed, highlighting the importance of a multidisciplinary approach in managing neuropsychiatric cases. The cases included chronic migraine with medication overuse, memory dysfunction with language and behavioral problems, refractory epileptic seizures with subjective sensory symptoms, bipolar affective disorder with normal pressure hydrocephalus, postherpetic neuralgia in a case with bipolar affective disorder, and psychosis with recurrent attacks with the abuse of several substances. CONCLUSION: A biopsychosocial multidisciplinary approach is essential for managing neuropsychiatric cases effectively on behalf of the patients and public health of the country. The CARE framework can guide the reporting and evaluation of case reports in clinical practice, ensuring that patients receive comprehensive and effective care. Healthcare providers should collaborate to provide the best possible care for patients with complex and multifaceted needs.

Functional Movement Disorder and Parkinson's Disease Comorbidity: A Case Report. / Fonksiyonel Hareket Bozuklugu ve Parkinson Hastaligi Es Tanisi: Bir Olgu Sunumu.

Functional movement disorders (FMD) are abnormal involuntary movements that are not attributable to known neurological and neuroanatomical causes. In the past decade, FMD diagnoses have been based on positive factors that are inconsistent with neurological disorders and not on the exclusion of neurological disorders. In this report, we presented the case of a female patient who had been followed up for 4 years in multiple health centers with the diagnosis of a neurological disorder which was suspected in the previous 1 year to be of psychogenic origin. A neurological disorder comorbid with depression and FMD was diagnosed after admission as an inpatient to our clinic. By presenting this case, it was intended to emphasise the importance of follow up after diagnosing FMD, given its common basis with Parkinson's disease and the high incidence of comorbidites seen with it. Imaging and elecrophysiological techniques should be relied upon.for differentiating FMD and neurological diseases. Although psychological causes are significant disease risk and/or maintenance factors, they are not sufficient for explaining the aetiology of FMD, which requires a multidisciplinary approach. Keywords: Functional movement disorders, Parkinson's disease, DaTscan.

Neuropsychiatric Effects of COVID-19 Pandemic on Alzheimer's Disease: A Comparative Study of Total and Partial Lockdown.

Objectives: Coronavirus disease 2019 (COVID-19)-related lockdown may have a negative effect on the neuropsychiatric status of Alzheimer's disease (AD) cases. In this study, it was aimed to find future implications by evaluating the neuropsychiatric conditions of AD cases during total and partial lockdown periods. Methods: It is a prospective, cross-sectional, and multicenter study that includes AD cases which have been followed for at least 1 year by outpatient clinics from different regions of Turkey. Sociodemographic data, comorbidities, mobility, existence of social interactions, clinical dementia rating (CDR) scale, and neuropsychiatric inventory (NPI) for total and partial lockdown were questioned by the caregivers with the help of case files of the patients. Results: A total of 302 AD cases were enrolled to the study (mean age: 78±8 years, mean duration of education: 5.8±9 years). The total comorbidity ratio was found to be 84%, with the most frequent comorbidity being hypertension. The mean NPI score was 22.9±21 in total lockdown and 17.7±15 in partial lockdown, which is statistically significantly different. When lockdown periods were compared with the total scores of NPI scores according to gender, existence of social interactions, mobility, and comorbidities were found higher in the total lockdown than the partial lockdown. When switching from total lockdown to partial lockdown, the presence of comorbidities, mobility, and CDR were found to be factors that had a significant effect on NPI scores. In regression analysis, CDR score was found as the most effective parameter on the neuropsychiatric status of AD cases for both lockdown periods. Conclusion: When lockdown-related restrictions were reduced, the neuropsychological conditions of AD cases were significantly improved. Lockdown rules should be considered with these data in mind.

The reducing effect of agomelatine on pentylenetetrazol-induced convulsions.

INTRODUCTION: Agomelatine is a potent MT1 and MT2 melatonin receptor agonist and a 5-HT2C serotonin receptor antagonist. The purpose of this study was to show the convulsion-reducing effect of agomelatine, in both clinical and electrophysiological terms, in a pentylenetetrazole (PTZ)-induced experimental epilepsy model in rats. METHODS: The anticonvulsant activity of agomelatine (25 and 50 mg/kg) was evaluated in rat models of PTZ (35 and 70 mg/kg) and compared with the control groups. RESULTS: Agomelatine administration at doses of 25 and 50 mg/kg resulted in a statistically significant decrease in convulsion scores and time to onset of myoclonic jerks compared to the control groups. In addition, comparison of the two doses employed showed that high-dose agomelatine (50 mg/kg) was significantly more effective than the lower dose. In addition to previous studies, we investigated the anticonvulsant effect of agomelatine using electroencephalogram (EEG). Administration of agomelatine at doses of 25 and 50 mg/kg in PTZ-induced seizures caused a significant decrease in the percentage of peak at EEG. DISCUSSION: Our results suggest that agomelatine has anticonvulsant activity shown in PTZ-induced seizure model. The results also give some evidences that agomelatine can use on epileptic seizures, but more studies are needed.